Christenson et al developed a clinical prediction rule for discharge of patients with opioid overdose from the Emergency Department after a period of observation. This can help identify a group of patients at low risk for serious short-term sequelae.
Patient selection:
(1) Patient with presumed opioid overdose, responsive to administration of naloxone.
(2) Observation for 1 or more hours after administration of the naloxone, watching for central nervous system depression, hypoxemia, or other complications.
Criteria for discharge after observation – all of the following:
(1) able to ambulate/walk
(2) oxygen saturation > 92% on room air
(3) respiratory rate 10-20 breaths per minute
(4) body temperature 35.0 to 37.5°C
(5) heart rate of 50-100 beats per minute
(6) Glasgow Coma Score (GCS) of 15 (normal)
The patient should be given an appointment for drug counseling and preferably should be discharged into the care of a responsible adult.
There are some situations where caution may be indicated in applying the rule. These might include:
(1) a patient with polypharmacy (with residual effects of alcohol or other drugs)
(2) drug adulterated with contaminant having possible CNS effect
(3) the patient intends to drive home
